The swine flu remains an "outbreak" not a "pandemic," but global health officials are warning that it could turn into one. The virus is now in at least 10 countries and World Health Organization has raised its pandemic threat level to Phase 5. How prepared are the states after shedding thousands of workers in their health departments? The Takeaway is joined by Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials.
"The public health community at the state, local and federal level has been preparing for years for a pandemic. We are well-prepared. We have plans, they've been exercised, they've been drilled and right now they're being put in place across the country." —Dr. Paul E. Jarris on the nation's preparedness for a flu pandemic
Todd Zwillich, The Takeaway: Ninety-one cases of H1N1, otherwise known as swine flu, confirmed in the United States as of this morning, according to the CDC. Fifty-one of those here in New York City. Close to 2,500 cases suspected in Mexico and 168 suspected deaths. So far, the swine flu in the United States is still an outbreak not a pandemic, so far. But global health officials are warning that it could turn into a pandemic very soon. The virus is now in at least ten countries. Yesterday, the WHO raised the global pandemic level to 'five' out of a total of 'six.' So how prepared are we here in the States? A lot of our public health infrastructure and our response to outbreaks like this are in the state and local level. The government oversees it, but when you’re in the community and you go to the clinic or someone comes to take care of a pandemic or an outbreak, it’s usually your local public health department and your county public health department. So how are those departments functioning? A lot of them have lost a lot of workers in this economy as states and counties shed jobs because their budgets are tight too. Dr. Paul Jarris is executive director of the Association of State and Territorial Health Officials. He’s joining us from Washington D.C. He’s the guy who represents all of these state and county health departments that respond to outbreaks like this on the front lines. Dr. Jarris, I want you to listen to something really quick. This is from the president’s news conference last night as he addressed money that he is trying to get out of Congress to help local health departments.
President Barack Obama [on tape]: I’ve requested an immediate $1.5 billion in emergency funding from Congress to support our ability to monitor and track this virus, and to build our supply of antiviral drugs and other equipment. And we will also ensure that those materials get to where they need to be as quickly as possible.
Todd Zwillich: Dr. Jarris, $1.5 billion, what is it going to go for?
Dr. Paul Jarris, the Association of State and Territorial Health Officials: Well I think the important thing to hear the president saying is $1.5 billion immediately. We do need that money immediately to jumpstart the response. Public health communities at the state, local and federal level have been preparing for years for a pandemic. We are well prepared. We have plans. They have been exercised. They have been drilled. And right now they’re being put in place across the country. But we know that as this thing escalates, which we believe it will, as we see on a day-to-day basis, that we’re going to need reinforcements. We’re going to need financial reinforcements to escalate the response and keep it moving vigorously. So what the president’s saying, clearly we will need money to continue to support a public health workforce that’s 24/7. At this point, we also need additional antivirals. We’ll need additional masks, gowns and other things to support the response to protect the public.
Todd Zwillich: Often, public health functions are the first thing to go in a bad economy or when states cut budgets. I was in the subcommittee the other day in the Senate in front of Tom Harkin’s subcommittee, when you testified along with Tony Fauci and CDC officials. You said that a lot of local health departments have less workers now than they did even two, three years ago. Is that true?
Dr. Paul Jarris: We’ve been looking at this very hard, in fact cooperating with our counterparts at the local county level, we represent the state level, and our estimates when we have a couple of Ph.D. researchers looking at this concurrently, we have approximately ten thousand, slightly more than ten thousand, job losses in public health at the state and local level in the past year and we anticipate this to continue given the state of the budgets that we’re facing at the local and state levels. So, yes, we have less workers than we had even a year ago.
Todd Zwillich: Can the money that the president is requesting go directly to hiring, and hiring skilled people?
Dr. Paul Jarris: That is our hope, our wish and, as you heard in the testimony, what we are testifying to request from the Congress and the president. The president’s request, actually, is a one-page letter to Congresswoman Pelosi and doesn’t specify precisely how the money goes, so he’s left that open for Congress to determine the best way to use the money.
Todd Zwillich: Dr. Jarris, health care in this country, as I know that you know, is notoriously variable. The quality, the access varies from state-to-state, locality-to-locality. Is it the same in public health? Do we see local public health infrastructure that’s really, really good in one state, but really poor in another? And if so what does that mean if H1N1 starts to spread countrywide?
Dr. Paul Jarris: Well our goal, of course, is to ensure that every American, or everyone living in this country, no matter where they live, has access to public health. And, just as we argue all the time that we should have universal health care benefits in this nation, we believe we should have universal public health coverage and we hope that is part of health reform.
Todd Zwillich: But is it very variable right now?
Dr. Paul Jarris: It is variable right now and the structural variability does not necessarily mean the service varies. I’ll give you an example. The first outbreaks here in California were in San Diego at Imperial County. There are local health departments in San Diego Imperial County. There’s, of course, the state health department that coordinates local health departments. Texas, however, was Bexar County where there is no local health department. However, the state provides the local services there. So it’s a mixed system where, in 27 states, the state is both some of the local care and the state care. So it’s a system of -- an overlapping system. The important thing is that the federal, state and local systems line up as one system.
Todd Zwillich: Well Dr. Jarris, before I let you go there’s one thing the president said last night at the news conference that bears repeating over and over and I want you to react to it if you’d listen to this.
President Obama [on tape]: Keep your hands washed. Cover your mouth when you cough. Stay home from work if you’re sick. And keep your children home from school if they’re sick.
Todd Zwillich: You want to react to that Dr. Jarris?
Dr. Paul Jarris: He is absolutely right and he gets a blue ribbon for public health. I was actually amazed at how fluent the president was on this issue last night. How well he spoke about it, how well he understood it and that’s a real testament to those who are briefing the president himself. Absolutely, the first person to rely on is yourself. The people you first need to rely on is your family. So, washing your hands. If you’re sneezing or coughing do it into a Kleenex. Throw that Kleenex out and wash your hands. If you don’t have a Kleenex, cough into your elbow. Frequent hand-washing is very important, for at least 20 seconds. So if you have kids, as NPR reported yesterday, have them sing the alphabet as they’re washing their hands. That’s about 20 seconds.
Todd Zwillich: Alright, Dr. Jarris, well the message is wash your hands, wash your hands, wash your hands. Dr. Paul Jarris, the executive director of the Association of State and Territorial Health Officials. Thanks for joining us, from Washington. We appreciate it. Wash your hands.
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